Fla. Admin. Code Ann. R. 64B8-4.009 - Applications

(1) All persons applying for licensure shall submit an application to the Department. The application shall be made on the applicable form set forth below, all of which are hereby adopted and incorporated by reference and can be obtained from the website at http://www.flhealthsource.gov/mqa-services. The application must be accompanied by the application fee.
(a) DH-MQA 1000, entitled "Medical Doctor Application for Licensure by Examination," (Revised 12/24), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-17934, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;
(b) DH-MQA 1008, entitled "Medical Doctor Application for Limited Licensure," (12/20), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-12831, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;
(c) DH-MQA 1009, entitled "Temporary Certificate for Medical Doctors to Practice in an Area of Critical Need," (02/21), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-13217, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;
(d) DH-MQA 1032, entitled "Application for Intern/Resident/Fellow or House Physician Initial or Renewal Registration," (Revised 9/2024), http://www.flrules.org/Gateway/reference.asp?No=Ref-17946;
(e) DH-MQA 1072, entitled "Application for Medical Faculty Certificate for Allopathic Physicians," (Rev. 6/2024), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-16987, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html;
(f) DH-MQA 1079, entitled "Temporary Certificate for Visiting Physicians to Obtain Medical Privileges for Instruction Purposes in Conjunction with Certain Plastic Surgery, Medical or Surgical Training Programs and Educational Symposiums," (10/2022), http://www.flrules.org/Gateway/reference.asp?No=Ref-14982.
(g) DH-MQA 5001, entitled "Rear Admiral LeRoy Collins, Jr., Medical Doctor Application for Temporary Certificate to Practice in an Area of Crital Need for Active Duty Military and Veterans," (02/21), http://www.flrules.org/Gateway/reference.asp?No=Ref-13218.
(h) DH-MQA 5055, entitled "Application for Public Health Certificate," (12/20), http://www.flrules.org/Gateway/reference.asp?No=Ref-12838.
(i) DH-MQA 5056, entitled "Application for Public Psychiatry Certificate," (12/20), http://www.flrules.org/Gateway/reference.asp?No=Ref-12839.
(j) DH-MQA 5058, entitled "Temporary Certificate for Visiting Physicians in Cancer Centers," (10/2022), http://www.flrules.org/Gateway/reference.asp?No=Ref-14983.
(k) DH-MQA 5089, entitled "Application for Graduate Assistant Physician Initial or Renewal Limited License," (6/2024), available from http://www.flrules.org/Gateway/reference.asp?No=Ref-17146, or http://www.doh.state.fl.us/mqa/medical/me_applicant.html.
(2) Applicants for licensure pursuant to subsection (1) are required to provide an official verification of the applicant's medical education from the medical school which comes directly from the medical school to the Board office, unless the applicant has had his or her medical credentials evaluated by the Educational Commission for Foreign Medical Graduates (ECFMG) and holds an active, valid certificate issued by the ECFMG.
(3) All applicant must submit examination score reports which come directly from the testing entity to the Board office.
(4) An applicant for licensure by endorsement pursuant to section 456.0145(2), F.S., shall submit as part of his or her application DH-MQA-5103, entitled "Mobile Opportunity by Interstate Licensure Endorsement (MOBILE)", (12/2024), which is incorporated herein by reference and which may be obtained from http://www.flrules.org/Gateway/reference.asp?NoRef-17933, Board office, or at http://www.doh.state.fl.us/mqa/medical/me_applicant.html. Applicants for licensure shall meet and comply with all requirements in Section 456.0145(2), F.S.

Notes

Fla. Admin. Code Ann. R. 64B8-4.009

Rulemaking Authority 456.013, 456.0145(5), 456.025, 456.031, 456.033, 458.309, 458.311, 458.313, 458.3145, 458.3151, 458.345 FS. Law Implemented 456.013(1), (2), (13), 456.0135, 456.025, 456.031, 456.033, 456.039, 456.049, 456.50, 456.0635, 458.311, 458.3124, 458.313, 458.3137, 458.3145, 458.315, 458.3151, 458.316, 458.3165, 458.317, 458.320, 458.345, 766.314 FS.
New 3-31-80, Amended 12-4-85, Formerly 21M-22.09, Amended 9-7-88, 3-13-89, 1-1-92, 2-21-93, Formerly 21M-22.009, Amended 11-4-93, Formerly 61F6-22.009, Amended 11-15-94, 2-15-96, Formerly 59R-4.009, Amended 7-10-01, 1-31-02, 5-10-04, 5-20-04, 6-13-06, 12-26-06, 1-18-09, 3-17-09, 10-7-09, 1-7-10, 5-18-10, 2-28-12, 1-27-13, 8-5-13, 11-10-13, 1-9-14, 7-15-14, Amended by Florida Register Volume 40, Number 166, August 26, 2014 effective 9/10/2014, Amended by Florida Register Volume 40, Number 224, November 18, 2014 effective 12/2/2014, Amended by Florida Register Volume 41, Number 042, March 3, 2015 effective 3/17/2015, Amended by Florida Register Volume 41, Number 087, May 5, 2015 effective 5/19/2015, Amended by Florida Register Volume 41, Number 179, September 15, 2015 effective 9/28/2015, Amended by Florida Register Volume 41, Number 209, October 27, 2015 effective 11/11/2015, Amended by Florida Register Volume 42, Number 149, August 2, 2016 effective 8/14/2016, Amended by Florida Register Volume 42, Number 178, September 13, 2016 effective 9/26/2016, Amended by Florida Register Volume 43, Number 015, January 24, 2017 effective 2/6/2017, Amended by Florida Register Volume 43, Number 206, October 24, 2017 effective 11/6/2017, Amended by Florida Register Volume 44, Number 030, February 13, 2018 effective 2/26/2018, Amended by Florida Register Volume 45, Number 034, February 19, 2019 effective 3/3/2019, Amended by Florida Register Volume 46, Number 176, September 9, 2020 effective 9/23/2020, Amended by Florida Register Volume 47, Number 061, March 30, 2021 effective 4/11/2021, Amended by Florida Register Volume 47, Number 125, June 29, 2021 effective 7/13/2021, Amended by Florida Register Volume 49, Number 006, January 10, 2023 effective 1/23/2023, Amended by Florida Register Volume 50, Number 182, September 17, 2024 effective 10/3/2024, Amended by Florida Register Volume 50, Number 212, October 29, 2024 effective 11/14/2024, Amended by Florida Register Volume 51, Number 063, April 1, 2025 effective 4/15/2025.

New 3-31-80, Amended 12-4-85, Formerly 21M-22.09, Amended 9-7-88, 3-13-89, 1-1-92, 2-21-93, Formerly 21M-22.009, Amended 11-4-93, Formerly 61F6-22.009, Amended 11-15-94, 2-15-96, Formerly 59R-4.009, Amended 7-10-01, 1-31-02, 5-10-04, 5-20-04, 6-13-06, 12-26-06, 1-18-09, 3-17-09, 10-7-09, 1-7-10, 5-18-10, 2-28-12, 1-27-13, 8-5-13, 11-10-13, 1-9-14, 7-15-14, 9-10-14, 12-2-14, 3-17-15, 5-19-15, 9-28-15, 11-11-15, 8-14-16, 9-26-16, 2-6-17, 11-6-17, 2-26-18, 3-3-19, 9-23-20, 4-11-21, 7-13-21, 1-23-23.

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